2013年 · 第51卷第12期

The child, a 13-year-old student, was admitted to the emergency department for "chest pain after activity, dyspnea for 9 h". 9 h ago, the child suddenly developed persistent severe chest pain after a lot of activities in physical education class, accompanied by dyspnea, coughing pink foamy sputum, nausea, vomiting, etc., and did not improve after treatment in the local hospital. No previous special medical history. Physical examination: heart rate 140 beats/min, breathing 40 beats/min, blood pressure 90/60 mm Hg (1 mm Hg =0.133 kPa), consciousness, lethargy, cyanotic lips, full jugular vein, and extensive wet rales audible in both lungs. The boundary of heart turbidity was not large, the heart rate was 140 beats/min, the rhythm was uniform, and no pathological murmur was heard in the auscultation area of each valve. The abdomen is flat and soft, the liver and spleen are not reached under the ribs, there is no edema in both lower limbs, and the limbs are warm. Auxiliary examination: ECG: I, aVL, V_1～4Lead ST segment arch dorsal upward elevation 0.1~0.3 mV, I, aVL, V_1～3Lead abnormal Q wave (Figure 1)。 Laboratory tests : CK 7726 U/L, CK-MB 412 U/L, TnI 19.48 μ g/L, WBC 21.92×10⁹/L, N 92.1%, brain natriuretic peptide precursor 3506 ng/L, blood pH 7.36, carbon dioxide partial pressure 41 mm Hg, oxygen partial pressure 36 mm Hg, oxygen saturation 66%. Admission diagnosis: coronary heart disease, acute anterior and high lateral wall myocardial infarction, Killip grade III. After admission, he was given anti-platelet, control heart failure, non-invasive ventilator positive pressure ventilation and other treatments, and his condition gradually stabilized. The results of coronary CT angiography on the 10th day of admission showed that the right coronary artery ran normally, and the left coronary artery originated from the right coronary sinus, ran between the aorta and the pulmonary artery, and entered the left coronary artery blood supply area through the front of the aorta (Figure 2), the two-dimensional curved surface reconstruction image showed no obvious stenosis of the right coronary artery and the left coronary artery main trunk, anterior descending branch and circumflex branch. The child was followed up in the outpatient clinic of our hospital for 10 months after discharge, without special discomfort.

Toll-like receptors (TLRs), as a transmembrane signaling receptor, are an important component of innate immune pattern recognition receptors. They play an important role in recognizing pathogenic microorganisms, triggering innate immunity and affecting acquired immunity, and are the first-line weapons for immune system to quickly resist infection by pathogenic microorganisms. At present, there are more than 10 kinds of TLRs, which are similar in structure and composition. They are all type Ⅰ transmembrane proteins, which are composed of extracellular region, transmembrane region and intracellular region. There are great differences in extracellular region between different TLRs, which is helpful to identify different ligands. TLR9 is a member of the TLRs family and is expressed in a variety of human cells, including B cells, plasma dendritic cells, natural killer cells, monocytes-macrophages, activated neutrophils, etc. Cell localization is mostly believed to be localized in the intracellular endoplasmic reticulum, but it is also reported that it is expressed in both the cell and the cell surface^[1]Similar to other pattern recognition receptors in the body, TLR9 recognizes specific pathogen-related molecular patterns-bacterial or viral non-methylated CpG-DNA sequences, mediates myeloid differentiation factor 88 (MyD88) -dependent signaling pathways, activates multiple cytokine gene transcription, and initiates immune responses. TLR9 gene is a highly polymorphic gene sequence. In recent years, researches at home and abroad have shown that its single nucleotide gene polymorphism is involved in the pathogenesis of many diseases, including infectious diseases, tumors, autoimmune diseases and specific reactive diseases, and is closely related to a variety of disease susceptibility. This paper reviews the research of TLR9 gene polymorphism and infection-related diseases.

The 12th National Academic Conference on Pediatric Liver Diseases and Infectious Diseases, sponsored by the Children's Liver Diseases and Infectious Diseases Group of Infectious Diseases Branch of Chinese Medical Association, hosted by Nanjing Second Hospital, and co-organized by the editorial department of Chinese Journal of Infectious Diseases, was successfully held in Nanjing, Jiangsu Province from August 22 to 25, 2013. 106 delegates from 23 provinces, municipalities and autonomous regions, including the Hong Kong Special Administrative Region, attended the meeting. Professor Miao Xiaohui, Vice Chairman of Infectious Diseases Branch of Chinese Medical Association and Editor-in-Chief of Chinese Journal of Infectious Diseases, delivered a speech on behalf of Infectious Diseases Branch of Chinese Medical Association. Academician Zheng Shusen and Professor Miao Xiaohui of Chinese Academy of Engineering and Professor Zhao Wei, President of Nanjing Second Hospital, personally attended the meeting and gave wonderful lectures. The conference received 78 papers and presentations. After expert review, 13 special reports and 24 speeches at the conference were made. The topics of the conference covered various fields of infectious diseases and liver diseases in children. The topics of the special report included liver transplantation treatment of end-stage liver diseases in children, drug-induced liver injury, autoimmune hepatitis, infant cholestasis, nutritional therapy of chronic liver diseases and the application of molecular diagnostic technology in childhood liver diseases, new progress in the treatment of hepatitis B and hepatitis C in children, maternal-infant blockade of hepatitis B, diagnosis and treatment of cytomegalovirus (CMV) diseases in children, and the latest progress of human infection with H7N9 avian influenza, hand-foot-mouth disease, childhood tuberculosis.

Canada's medical system is a universal free medical system based on high taxes. It was once praised by former US President Bill Clinton as "the best social medical system in the world". The high medical expenses of the neonatal intensive care unit (NICU) are all paid by the government, which completely solves the interference caused by family members and neonatologists due to economic factors. In Canada, provinces determine the number of NICUs at a rate of 1 NICU per 1 million people. NICUs are all set up in affiliated hospitals of universities, with concentrated medical resources, excellent equipment and advanced technology. The medical level of NICU in each province is similar, and the management model is also very similar.